Abstract
.Bangladesh introduced hepatitis B vaccine in a phased manner during 2003–2005 into the routine childhood vaccination schedule. This study was designed to evaluate the impact of the introduction of hepatitis B vaccine in Bangladesh by comparing hepatitis B surface antigen (HBsAg) prevalence among children born before and after vaccine introduction and to estimate the risk of vertical transmission of chronic hepatitis B virus (HBV) infection from mother to infant. We also evaluated the field sensitivity and specificity of an HBsAg point-of-care test strip. We selected a nationally representative sample of 2,100 prevaccine era and 2,100 vaccine era children. We collected a 5-mL blood sample from each child. One drop of blood was used to perform rapid HBsAg testing. If a child had a positive HBsAg test result with the rapid test, a blood sample was collected from the mother of the HBsAg-positive child and from the mothers of two subsequently enrolled HBsAg-negative children. All samples were tested for serologic markers of HBV infection using standard enzyme-linked immunosorbent assay. One (0.05%) child in the vaccine era group and 27 (1.2%; 95% confidence interval [CI]: 0.8–1.7%) children in the prevaccine era group were HBsAg positive. Mothers of HBsAg-positive children were more likely to be HBsAg positive than mothers of HBsAg-negative children (odds ratios = 4.7; 95% CI: 1.0–21.7%). Sensitivity of the HBsAg rapid test was 91.2% (95% CI: 76.6–98.1%) and specificity was 100% (95% CI: 99.9–100%). The study results suggest that even without a birth dose, the hepatitis B vaccine program in Bangladesh was highly effective in preventing chronic HBV infection among children.
Highlights
Hepatitis B virus (HBV) infection is a leading cause of morbidity and mortality worldwide because of hepatocellular carcinoma and liver cirrhosis.[1]
The study results suggest that even without a birth dose, the hepatitis B vaccine program in Bangladesh was highly effective in preventing chronic hepatitis B virus (HBV) infection among children
The results show that the program was highly successful in reducing chronic HBV infection among children
Summary
Hepatitis B virus (HBV) infection is a leading cause of morbidity and mortality worldwide because of hepatocellular carcinoma and liver cirrhosis.[1] Globally, about 248 million people are chronically infected with HBV2; an estimated 686,000 HBV-related deaths occur, most of which result from the complications of chronic HBV infection, for example, liver failure and hepatocellular carcinoma.[3] Hepatitis B virus is transmitted by percutaneous and permucosal exposure to infected blood and other body fluids.[4] In highly endemic countries (hepatitis B surface antigen [HBsAg] prevalence 3 8%), the most common routes of transmission of HBV are from mother to child at birth or from person to person in early childhood.[5,6,7] In low endemic countries, mother-to-child transmission or early childhood transmission may account for more than one-third of chronic HBV infections.[8,9]. HBV vaccination status of children Vaccine card available Number of HBV vaccine doses received‡ 0 1 2 3 Unknown.
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